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The effect of changes in tooth position of unerupted canines on cephalograms.

Although many radiographic procedures have been described to localize an impacted canine, they all submit the patient to extra radiation. The purpose of the entire study was to evaluate if the combined interpretation of cephalograms and dental panoramic tomograms (DPTs), which are used in orthodontic practice, can provide adequate information as to the position of impacted canines. In a previous study the radiographic image of impacted canines on DPTs was evaluated. In this investigation, the effect of changes in position and inclination of an impacted canine on cephalograms was studied in an experimental set-up. An upper canine was removed from a human skull and placed in a positioning device to imitate various positions of impaction. Starting from a buccally impacted position, three different displacements were simulated: 10 mm frontally, 10 mm sagittally, and 5 mm vertically. In each of these positions nine different changes in inclination (in the sagittal and the frontal plane) were registered, resulting in 36 different cephalographic exposures. Analysis revealed the following: the degree of vertical and sagittal displacement of the incisal point of the impacted canine, the angulation of the tooth as well as the tooth length, measured on a cephalogram, appeared to give an accurate representation of the experimental set-up. Combining these findings and those from the previous study, it became possible to define a series of points to enable an adequate three-dimensional (3D) estimation of the canine's position. A clinical case of an impacted canine is used as an illustration of this experimental set-up.

Cephalometry↗

Morphology of anterior teeth associated with displaced canines.

This clinical study compared tooth dimensions of maxillary central and lateral incisors on the same side as a palatally impacted maxillary canine with those of the contralateral side with a normally erupted canine, in a group of 33 consecutively referred patients. The dimensions recorded were the mesio-distal width, labio-palatal depth, obtained from models of the four upper anterior teeth and total tooth length obtained from an orthopantomographic radiograph. The results showed that there was no statistically significant evidence to support the view that palatally impacted maxillary canines are associated with diminutive maxillary lateral incisors.

Adolescent↗

Le Fort I osteotomy with sparing fracture of lateral pterygoid plate.

This study aimed to clarify the relation between the anatomical variations of the pterygomaxillary region and fracture of the pterygoid plate during Le Fort I osteotomy. We present a secure method to separate maxillary tuberosities from pterygoid plates without injuring the pterygoid plates. Thirty specimens of hemisection of Korean skulls were used for the study. The maxilla was sectioned transversely on the floor of the pyriform aperture and posteriorly to the lateral pterygoid plate with a mechanical saw. The section was 5 to 6 mm above the tooth roots. The pterygomaxillary junction was separated with a curved osteotome in two steps: initially with light tapping of the shallow groove 2 to 3 mm anterior to the pterygomaxillary fissure at a half right angle and then changing the course of forceful tapping to more than 60 degrees. The maxillary tuberosity separated from the medial and lateral pterygoid plates during the procedure was grouped into the "disjunction group" (24 of 30, 80%) and the pterygoid plates fractured were grouped into the "fracture group" (6 of 30, 20%). The thickness of the pterygomaxillary region (T) was significantly greater in the disjunction group than in the fracture group (P = 0.034). The concavity of the pterygomaxillary fissure (C) was significantly deeper in the disjunction group than in the fracture group (P = 0.020). There was no significant difference of width of the pterygomaxillary fissure between the disjunction group and the fracture group (P = 0.169). The thin pterygomaxillary region and less concave pterygomaxillary fissure on the preoperative computed tomography scan draw precautionary attention to vulnerable pterygoid plates fractured in the procedure of Le Fort I osteotomy.

Adult↗

Bone allografts in periodontal therapy.

Bone allografts as used in dentistry have a 20-year history of safety and efficacy. Case reports and controlled clinical trials have shown the potential of both mineralized and decalcified cortical freeze-dried bone allograft to reconstruct the bone defects caused by periodontitis. Histomorphometric analysis of human biopsies following grafts of decalcified freeze-dried bone allograft have shown the ability of decalcified freeze-dried bone allograft to promote regeneration of new bone, cementum, and periodontal ligament on a tooth root surface previously exposed to bacterial plaque. The addition of mineralized freeze-dried bone allograft and decalcified freeze-dried bone allograft to the guided tissue and guided bone regeneration procedures have significantly enhanced results, especially in large osseous lesions.

Animals↗

A review of 47 cases of unerupted maxillary incisors.

OBJECTIVES: To study the prevalence of aetiological factors associated with unerupted maxillary incisors and to follow the outcome of treatment in a study of 47 cases. DESIGN: A retrospective study. SETTING: The Dental Department, St Luke's Hospital, Malta, the School Dental Clinic of Malta and the private practices of two orthodontists in Malta. SAMPLE AND METHODS: Forty-seven patients with a total of 53 unerupted maxillary incisors were classified according to the aetiological factors causing non-eruption. The relative prevalence of the various aetiologies were ascertained, and the outcome after treatment was recorded to assess the efficacy of the treatment methods being used. RESULTS: The most common cause of lack of eruption was the presence of supernumerary teeth (47% of patients). The other 53% of cases were distributed more or less equally between the remaining aetiological factors, which were odontomes (9%), dilacerations (9%), tooth germ malposition (12%), crowding (4%), one case of a calcifying odontogenic cyst (2%) and one case of trauma to the preceding deciduous tooth (2%). The aetiology of 15% of cases could not be ascertained. Once supernumerary teeth were removed, maxillary incisors usually erupted successfully with the help of conventional treatment methods such as surgical exposure and orthodontics. A relatively large number of incisors that failed to erupt due to other aetiological factors had to be extracted. CONCLUSIONS: Maxillary incisors that fail to erupt due to the presence of supernumerary teeth have a better prognosis than unerupted incisors with less common aetiologies.

Adolescent↗

The instantaneous centre of rotation of a fixed unilateral distal extension partial denture.

A photographic technique was used to determine the instantaneous centre of rotation of a fixed unilateral distal extension partial denture and the teeth to which it was attached. The teeth involved were the lower canine and first premolar. When the two crowns were splinted together to provide support, both vertical and lateral saddle movement was reduced. Saddle support using only the first premolar produced a centre of rotation in the sagittal plane below the canine crown--which became located anterior to the canine when the two supporting teeth were splinted together. In the coronal plane, canine support produced an axis of rotation buccal to, and outside the confines of, the model; splinting of the canine and first premolar caused the centre of rotation in this plane to be located buccally and superior to the abutment tooth roots. The more posteriorly the saddle was loaded, the greater was the magnitude of the resultant movement.

Biomechanical Phenomena↗

Binding of Actinomyces viscosus to collagen: association with the type 1 fimbrial adhesin.

Treatment of hydroxyapatite (HA) with human type I or type III collagen strongly promoted adhesion of Actinomyces viscosus LY7 cells. Treatment with human type V collagen was somewhat less effective while treatment with human type IV or rat type I collagen was significantly less effective. Electron microscopic observations revealed that A. viscosus cells also attached to fibrils prepared from human type I collagen. The alpha 1 (1) polypeptide chain derived from type I collagen was ineffective in promoting binding and the alpha 2 (1) polypeptide chain exhibited moderate activity. Heat- or urea-denatured type I collagens were also ineffective in promoting binding. Mutants of A. viscosus that possess type 1 fimbriae, but not type 2 fimbriae or no fimbriae, also bound to collagen-treated HA; this suggests that the adhesin responsible was associated with type 1 fimbriae. Strains of Actinomyces israelii and Actinomyces odontolyticus also exhibited strong binding to collagen-treated HA, while Actinomyces naeslundii ATCC 12104 did not. The avidity of Actinomyces species for collagen would seem to be at least partially responsible for the high proportions of these organisms found on cemental and root tooth surfaces.

Actinomyces viscosus↗

Porphyromonas gingivalis lipopolysaccharide lipid A heterogeneity: differential activities of tetra- and penta-acylated lipid A structures on E-selectin expression and TLR4 recognition.

Porphyromonas gingivalis is a gram-negative bacterium strongly associated with periodontitis, a chronic inflammatory disease of the tissue surrounding the tooth root surface. Lipopolysaccharide (LPS) obtained from P. gingivalis is unusual in that it has been shown to display an unusual amount of lipid A heterogeneity containing both tetra- and penta-acylated lipid A structures. In this report, it is shown that penta-acylated lipid A structures facilitate E-selectin expression whereas tetra-acylated lipid A structures do not. Furthermore, it is shown that tetra-acylated lipid A structures are potent antagonists for E-selectin expression. Both tetra- and penta-acylated lipid A structures interact with TLR4 although experiments utilizing human, mouse and human/mouse chimeric TLR4 proteins demonstrated that they interact differentially with the TLR4 signalling complexes. The presence of two different structural types of lipid A in P. gingivalis LPS, with opposing effects on the E-selectin response suggests that this organism is able to modulate innate host responses by alterations in the relative amount of these lipid A structures.

Animals↗

Calcification associated with the nasolacrimal system of a horse: case report and mineralogic composition.

A 12-year-old Paso Fino mare was evaluated for a chronic nasal and ocular discharge. A calcification was identified eroding through the nasal mucosa of the middle meatus. Differential considerations for this mass included dacryolith, nasal calculus, or calcified tooth root abscess. Anatomical location and case history and progression supported a dacryolith. Following removal, the calculus was submitted for mineralogic analysis. The calculus was primarily carbonate hydroxylapatite (Ca10(PO4)3(CO3)3(OH)2) with a minor NaCl halite constituent. Dacryoliths, or nasolacrimal calculi, are an uncommon occurrence in animals, and sparsely reported in humans. The etiopathogenesis of dacryolith formation is unknown. The objective of this article was to report the first case report of an equine nasolacrimal system dacryolith and its mineralogic composition.

Animals↗

Endoscopic examination of normal paranasal sinuses in horses.

The frontal, caudal maxillary, and rostral maxillary sinuses of 10 equine cadavers were examined endoscopically, and the findings were confirmed by sinusotomy. Similar endoscopic examinations were performed in five conscious, adult horses by using sedation and local anesthesia. Useful portals of entry for the arthroscope in adult horses were: for the frontal sinus, 60% of the distance in a lateral direction from midline to the medial canthus and 0.5 cm caudal to the medial canthus; for the caudal maxillary sinus, 2 cm rostral and 2 cm ventral to the medial canthus; and for the rostral maxillary sinus, 50% of the distance from the rostral end of the facial crest to the level of the medial canthus and 1 cm ventral to a line joining the infraorbital foramen and the medial canthus. The frontal sinus portal was most useful for examination of the frontal and caudal maxillary sinuses. The caudal maxillary sinus portal was most useful for examining the sphenopalatine sinus. Structures in the frontal and caudal maxillary sinuses could be approached surgically by viewing them through the frontal sinus portal and guiding an instrument to them through the caudal maxillary sinus portal. Tooth root identification was reliable for the second and third upper molars in animals older than 5 years, but was more difficult for the rostral teeth and in younger animals. Endoscopy was not difficult to perform and was well tolerated in standing, sedated horses. The only complication of this procedure was mild, local subcutaneous emphysema that resolved spontaneously within 14 days.

Anesthesia, Local↗

Endoscopic examination and treatment of paranasal sinus disease in 16 horses.

Sixteen horses with suspected paranasal sinus disease had endoscopic examination of the paranasal sinuses with a 4.0 mm arthroscope either while standing and sedated (14 horses) or under general anesthesia (two horses). Endoscopic diagnosis included sinusitis (four horses), sinus cyst (three horses), hemorrhage (three horses), neoplasia (three horses), and tooth root abnormalities (two horses). No abnormalities were detected in one horse. Endoscopic findings concurred with the radiographic findings in 13 horses (81%). Samples of sinus contents for bacteriologic (eight horses) and histologic examinations (five horses) were obtained using sinus endoscopy. Diagnostic sinus endoscopy was combined with debridement, lavage, and suction as a therapeutic technique in 10 horses. In three horses, sinus exploration was performed after diagnostic endoscopy confirmed sinus disease, whereas in three horses, further therapy was not recommended after sinus endoscopy. Clinical signs of sinus disease resolved in 11 horses (69%) overall and in eight of 10 horses (80%) with sinusitis, cyst formation, or hemorrhage using endoscopic techniques alone. Mild, local subcutaneous emphysema occurred at the portal sites in all horses, but healing occurred without additional complications. Iatrogenic damage to sinus structures occurred in one horse. Sinus endoscopy was useful in the diagnosis and management of paranasal sinus disease and avoided the need for exploratory sinusotomy in some horses.

Animals↗

Pinless external fixation of mandible fractures in cattle.

OBJECTIVE: This report describes our experience with a new technique for stabilization of mandibular fractures in cattle using a pinless external fixator. STUDY DESIGN: Mandibular fractures were stabilized with a pinless external fixator, which is a modification of a unilateral AO/ASIF (Association for the Study of Internal Fixation)-fixator in which pins are replaced with bone clamps. ANIMALS: Seven dairy cattle between 1 and 5 years of age. METHODS: Fracture stabilization was achieved by using the pinless external fixator. Postoperative management included intravenous administration of sodium chloride-glucose and antibiotics. A suspension of ruminal contents from a normal cow together with linseed and grass pellets was administered with a gastric tube. RESULTS: Three to 10 days after surgery six of seven cows masticated comfortably. The only failure was a yearling with a 10-day-old open infected fracture. This animal was slaughtered 9 days after surgery because of additional problems. In six cases there was enough callus formation 33 to 54 days after surgery to stabilize the fracture. The fixation devices were removed under heavy sedation. The major complication was bone sequestration at the fracture site, which required additional treatment. CONCLUSION: The pinless fixator has proven satisfactory for external stabilization of unilateral horizontal ramus fractures of the mandible in cattle. CLINICAL RELEVANCE: The technique provides good stability without penetration of the medullary cavity and damage to the tooth roots. Other advantages of the technique include ease of application, minimal surgical trauma, and the short surgical time for application.

Animals↗

Permanent teeth in hypophosphatasia: light and electron microscopic study.

The changes in a permanent central incisor of a patient suffering from hypophosphatasia, were investigated light microscopically and compared with those of two of his primary teeth. In addition his other central incisor was studied with transmission and scanning EM. The changes in permanent teeth were similar to those of the primary dentition, including loss of cementum and the presence of deep resorption areas in dentin. Afibrillar cementum was detected with EM, and was attached to dentin surface. The presence of a thick layer of bacterial plaque was a prominent feature in all the teeth examined. A large number of bacteria was also found in resorption bays. It is suggested that bacteria may play an important role in the destruction of soft and hard tissues leading to loss of teeth in hypophosphatasia.

Child↗

Compound odontoma erupting in the mouth: 4-year follow-up of a clinical case.

A case of a compound odontoma erupting in the oral cavity is presented: a follow-up study of 4 yr has been performed evaluating the possible relationship with a previous dental trauma. A discussion is presented concerning the etiologic aspects, clinical signs, diagnostic aids and therapeutic approaches to this type of lesion.

Child↗

Transmission electron microscopic appearance of dentin matrix in type II dentin dysplasia.

Dentin matrix of demineralized primary and permanent teeth with type II dentin dysplasia was studied by transmission electron microscopy. The coronal dentin of a maxillary third molar exhibited a normal structure. In the radicular dentin, tubules were few in number; the major part of the dentin was composed of thick, curvy bundles of cross-striated collagen fibers. In the most aberrant areas of the radicular dentin, coarse collagen fibers measuring up to 140 nm in thickness were observed. The dentin of the primary tooth showed a similar, but somewhat less irregular, structure.

Collagen↗

Identification of calprotectin, a calcium binding leukocyte protein, in human dental calculus matrix.

Calprotectin is a calcium binding protein produced by leukocytes, macrophages and epithelial cells, and its levels in several tissues increase during infections and in many inflamed areas, suggesting that it may be an indicator of inflammatory activity. Osteopontin is a prominent phosphorylated glycoprotein in bone matrix, having calcium binding capacity. Recently, it has been reported that calprotectin and osteopontin are present in urinary stones (pathological mineralized masses in the body), and that these proteins may be involved in their formation. Dental calculus formed by mineralization of dental plaque is an inflammatory factor which may contribute to periodontal disease. It contains many organic components involved in mineralization. We recently found osteopontin molecules in human dental calculus and suggested that the components of its matrix may be similar to those of urinary stones. In this study, we investigated the presence of calprotectin in human dental calculus by immunohistochemical and immunoblotting analyses using a specific antibody for calprotectin. After fixation and demineralization of dental calculi adhered to tooth roots, sections embedded in paraffin were immunoreacted with the antibody for calprotectin and positive immunostaining for calprotectin was observed. Dental calculus proteins were then extracted with EDTA and separated by electrophoresis on 15% polyacrylamide gels. By immunoblotting analysis, 3 or 4 bands were observed at 11, 14.5, 22-25, 28 or 36.5 kDa and these patterns corresponded to those of calprotectin subunits. When non-immune rabbit serum was used instead of calprotectin-specific antibody as a negative control, no immunoreactivity was observed. These findings indicate that calprotectin is associated not only with antibacterial action but also with calcium binding capacity during dental calculus formation.

Calcium-Binding Proteins↗